Mindfulness and OCD

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Mindfulness and OCD

When I was a kid I remember visual illusion pictures that gained popularity called autostereograms.  In the picture, nothing was seen but two-dimensional colored dots that looked like a bad version of a Jackson Pollock painting.  But staring at the picture in a special way produced a three-dimensional image that appeared before you.  There was an episode of “Seinfeld” where Elaine tried to teach her boss, Mr. Pitt, how to see the image.  In the tense interaction he pleads desperately, “Where is it!?” and she instructs, “Unfocus your eyes!”  He cancels all of his meetings and spends the day staring at the picture, with increasing anxiety, trying to achieve the result.  The act of trying to force the result is the exact thing that prevents him from seeing the image.

While attempting to assert control over Obsessive-Compulsive Disorder (OCD), many react with resistance to present experiences which achieves the exact opposite of the desired result.  Mindfulness is a helpful component in the treatment of OCD.  Mindfulness can be defined as the act of paying attention to the present moment with openness, curiosity and non-judgment.  It involves acceptance of present observations and a willingness to experience them, even if they are unwanted OCD thoughts, feelings or bodily sensations.

In mindfulness and autostereograms, the experience of letting go of results needs to occur before there is ever hope of achieving results.  There are no step by step instructions.  It’s every man for himself and there is no guarantee of results.  A person must step into the dark, not knowing if they are wasting their time, and not knowing what the outcome might be.  And then all of a sudden, “What is happening?  Is this what I think this is?  Do I see something beginning to take shape?  Yes, I do see something.  Wow!  It is a dinosaur with a backpack and running shoes on!”  But the thing that is really amazing is that you become free.  You now have the freedom to look around the entire picture without staring.  This activity doesn’t cause the image to go away.

Everyone’s experience of mindfulness is different.  It is something that you must read about, hear about, talk about, and practice to find your own way with it.    There are so many facets to experience and a multitude of ways you can turn corners when finding new ways to exist in the moment.  You will pick up information and file it away.  A seed will be planted and it will bloom at some other time when you least expect it.

A good way to think about how to start the journey with mindfulness is to become a student.  And I’m not talking about the type of student who is caught smoking in the bathroom.  I’m talking about an assiduous student, a sponge, an eager beaver.  We must take an open-minded, active role in learning that doesn’t stop once we acquired the information.  It’s a practice for a lifetime. It’s a better way to live. Each of life’s experiences, internal and external, can be filtered through the screen of awareness, if we choose to allow it.  The body of knowledge grows and one’s mindfulness practice strengthens.  Every moment is a moment to practice.  And OCD experiences are no exception.

OCD is a disorder comprised of intrusive, unwanted thoughts, feelings and bodily sensations.  These internal experiences often feel unacceptable to the OCD sufferer.  The general response humans have when something is uncomfortable is to avoid and attempt to change the uncomfortable experience.  In OCD, these avoidance or neutralizing behaviors are called compulsions or rituals.  Rituals can be observable behaviors or mental actions.  In attempting to reduce uncomfortable thoughts or feelings by performing compulsions, OCD becomes reinforced.  For example, if a person reduces their anxiety by washing their hands after touching a “contaminated” door knob, the relief sends a false message that the door knob was harmful.  Mindfulness will assist a person in finding ways to make room for uncomfortable moments, which will ultimately weaken OCD because it helps to prevent rituals.

Suppose an OCD thought shows up that says, “Smother your baby with that pillow,” or feel free to insert any unwanted thought here.  This thought creates a good deal of anxiety and uncertainty.  The usual response of a client prior to treatment is to pay too much attention to the thought, assign meaning to the thought, and to try to control future occurrences of the thought.  To the OCD sufferer, the mere presence of the thought suggests there may be some danger looming.  The behavioral response is often resistance and panicked efforts to avoid having uncertainty about the feared outcome, in this case, harming your baby.  This will probably include an analysis of the thought in attempt to unbury its meaning.

There is a choice about how to respond to a thought like this.  The natural, knee-jerk reaction to something uncomfortable and uncertain is to resist having future occurrences of the thought to reduce doubt about your future actions.  If you react in this way, you’ll find your OCD patting itself on the back.  Mindfulness awards a person more freedom than a biological need to avoid pain.  Just like the autostereogram, you are free.  You are not bound by the idea that this thought can’t be or this feeling shouldn’t exist.  The thought does exist…the feeling does exist.  If you remember your mindfulness skills, all of a sudden there is a bigger space for the thought or feeling to reside.

What does it mean to make room for thoughts?  To paint a picture, imagine you are locked in a small closet with your thoughts.  There is barely any room to move and the thoughts are crowding you.  Now imagine you step into a big gymnasium with those thoughts.  You still occupy the same room as them, but they are much less intrusive.  All thoughts are allowed to float around, unobstructed.  They can enter and exit as they wish.  The content of the thought doesn’t matter, even if it seems particularly deplorable or insulting to what you value.  The response is the same.  What is here, is here, and it is acceptable.

Having OCD requires experiencing many painful thoughts and emotions, particularly before it has been treated.  There is a decision that one can make about how to respond to pain.  If there are only two choices: 1.) Thinking about killing someone while begging, bargaining, kicking and screaming that this thought is unacceptable OR 2.) Thinking about killing someone and accepting the thought, most clients can tell me that number 2 is the better choice.  The error that people make is the illusion of a 3rd choice.  Many OCD clients have a fantasy about a 3rd choice where they eliminate the thought.

None of us can control every thought that enters our brain, it is simply the nature of how thoughts work.  Believing or wishing that you can is an error that leads to a rejection of reality, an error that leads to additional suffering.  This is why I believe it may be easier to accept an irreversible condition such as having your leg bitten off by a shark, because there is not the illusion of control present in OCD.  This example is more absolute, so people become less caught up wishing for a different reality.  If there were a choice, I would be behind my clients 100% in trying to battle their OCD thoughts.  Since thoughts and feelings that arrive in the moment are outside of your control, the best response is acceptance.  The Buddhist proverb, “Pain in inevitable, suffering is optional,” can be used as a reminder to observe and accept intrusive, internal experiences on the path to lower suffering.

Without present moment focus, individuals with OCD may become very distressed.  Generally, if you ask an OCD sufferer how they are doing now, they admit they are handling the thought or emotion adequately despite discomfort.  It is often the frustration of how long they have been experiencing the thought (past-oriented thinking) or the fear of how long they will have to experience the thought (future-oriented thinking) that causes much of the resistance.  It is the waiting for the internal experience to end that is the problem.

I have experienced mindlessness and rejection of the current moment many times while taking yoga.   This phenomenon occurs when I am in a difficult pose and I am present and mindful.  Then the teacher says, “Three more breaths,” and I immediately reject the current moment and the struggle begins.  Suffering increases.  I am no longer present in the pose.  I’m comparing this moment of discomfort to how it will feel when I have relief from the pose.  Guess which one wins the comparison and ultimately my attention?  If I become aware of this shift, I can re-enter the moment through acceptance.  It is a pretty cool experience to play around with.

One of my clients shared a similar example when his sister was giving birth to her baby.  Her doctor told her to experience her contraction as if she would be in it forever.  Now that sounds a little nutty, right?  How could that possibly help?  Isn’t it your spouse’s job to watch the contraction monitor to tell you when your contraction is peaking, so you know it will be ending soon?  As counter-intuitive as it may seem, arriving in the discomfort and perceiving it as forever will allow you to live with it differently.  You will make room for the feeling, you have to.

In comparing current pain to a moment when you will have freedom from pain, the current moment will always lose, and internal resistance will increase.  And when struggle increases so will suffering…and the cycle continues.  With OCD spikes, live in the moment as if is it your new reality, as if you had chosen it.  Let go of results.  This is not to resign yourself to a lifetime of suffering, but to create a new relationship with anything scary or uncomfortable.

Imagine a person who wants to stop eating pizza to lose weight.  When he stops eating pizza, there may be strong urges or desire to eat it again.  Most likely, he wants the uncomfortable feelings of desire to go away and he wants thoughts about pizza to go away too.  Because the thoughts and feelings are uncomfortable and don’t go away, he eats pizza again and they go away temporarily.  When using a mindful approach, consider that it may be okay for desire and thoughts to be present.  Maybe he can sit with the desire and make room for it.  It can be liberating to have the freedom to choose, independent of thoughts and feelings.  He may even purposely think about pizza so the desire rises.  This way he can practice making room for desire.  This type of exposure can help him strengthen his mindfulness skills and be empowered to deal with all his difficult emotions.

I have treated OCD clients with beliefs that certain feelings should be matched to certain types of moments.  “I should feel sad at funerals and happy when I’m with my friends,” said a client expressing her emotional perfectionism.  I remember getting a relaxation massage and thinking I wasn’t enjoying it enough.  I thought, “Time is flying by, I must relax!”  I held the false belief that if I asserted control over my thoughts and feelings, I could change the experience, but the exact opposite happened.  This was lack of acceptance of the moment.  Even though it wasn’t exactly what I would have liked it to be, it was the reality of the moment.  It is okay that I had thoughts about the time.  It is okay that I wasn’t perfectly relaxed.  Facing reality will lower suffering, and mindfulness will open the door.

Meditation or yoga can create some powerful moments and magical feelings of oneness with being alive.  But these feelings of great connectedness with the world and who you are will not occur every time.  Going into the situation already trying to control it, “I would like to replicate that awesome meditation session I had last time,” is already attempting to control the process which is the opposite of living in the moment.  These desires are normal and innate, however.  So thoughts about what you want the moment to be will always arise.  That is okay because it is part of the moment.  So become the watcher of those thoughts too.

It is sometimes difficult for individuals with OCD, who experience discomfort with uncertainty and incompleteness, to learn a practice that does not have a step by step description or an emphasis on outcomes.  You may wonder how you are going to put the information from this article into practice for your OCD.  “Am I doing it right?  What will I get out of this?  Is it working?”  Doesn’t this sound familiar to Mr. Pitt trying to figure out the autostereogram?  Become the observer of those thoughts too.  Noticing when you are attached to results is mindfulness.  Try saying, “I just noticed a thought that I may not be able to do this.”  Watching this thought is mindfulness. You’re doing it.  Tell yourself, “Maybe I don’t have to change this moment….maybe it can be what it is.”  There is no amount of thoughts and feelings that you cannot handle.  Picture your internal experiences as if they are entering and exiting a waiting room you are sitting in…and just keep reading your magazine.

Stacey Kuhl Wochner, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD.  Follow her on Facebook.

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19 Comments

  1. Daniel August 26, 2013 at 11:34 pm - Reply

    The control aspect is so intense. It was purely internal, for me and my ocd a few years ago.
    As I didn’t have perfectionistic issues.

    mindfulness is a necessity.. its more mental blocks now and getting the brain flowing rather than slow and stalled by the kinds of thought processes you recognise here.
    I hope it gets easier.

    and hello again! I’m glad i came back.

  2. Keith F September 23, 2013 at 3:11 pm - Reply

    Hi Stacey,
    This is Keith Fraser. We spoke about a month ago about memory hoarding. Congratulations on another excellent and thought-provoking article. I am starting to come around on overanalyzing OCD. My only question is: Do you think the best approach to OCD is to keep an “it is what it is ” mentality? Essentially its quality of life that everybody is talking about. Or should I keep researching OCD and looking for that answer?
    Have a great day!
    Keith F

    • Stacey Kuhl-Wochner September 24, 2013 at 1:08 am - Reply

      Hi Keith, Thanks for reading and commenting on my article. Becoming an expert on your OCD is helpful in order to learn how to respond to it in a way that does not exacerbate your symptoms. Research can become compulsive, however, if it is excessive and you are using it as a response to an OCD spike. Every moment “is what it is” for all of us. It is best to accept the moment and what it offers. Over time you can change your relationship with thoughts and feelings and your quality of life can improve.

  3. victoria March 26, 2014 at 4:38 am - Reply

    Thank you so much for this article!! I found it very usefull…
    Something that caught my attention was the concept of “emotional perfectionism”… and the pressure that comes along with it.
    The picture of sharing the tiny closet with all the giant thoughts was a matching example of the way it feels. And the picture of the gymnasium… was absolutely liberating. It gave me my breath back. Not only can we get freedom to move and walk even though those feelings or thoughts are there sharing our space, but also there is room for pleasent feelings and positive experiences as well.

    I’m looking forward to be a good student in mindfullness 🙂 thank you!!

    • Stacey Kuhl-Wochner March 28, 2014 at 3:08 am - Reply

      Hi Victoria,
      Thanks for your comments. I’m glad you read the article and found it helpful. You make an excellent point – making room for uncomfortable internal experiences also creates space for more pleasant ones as well!

  4. Anthony N April 13, 2014 at 4:40 am - Reply

    Hi Stacey

    After 17 years of Pure O I have now finally begun to start accepting my thoughts, feelings & sensations as inevitable & a part of the condition. However Accepting / Allowing often causes more rumination. isn’t the whole idea to focus as little as possible on these and move on to other thoughts.

    Thanks for any advice
    Anthony

    • Stacey Kuhl-Wochner April 14, 2014 at 7:49 pm - Reply

      Hi Anthony, Pushing out thoughts does not work because we don’t get to choose our thoughts, feelings and bodily sensations, they just happen. If you have OCD you may experience an increased desire to ruminate, or do mental rituals because allowing an unwanted thought to be present creates increased anxiety and uncertainty. It is basically a type of exposure to accept thoughts. Your practice is to become the observer of whatever is present in the moment. This may involve understanding and labeling mental rituals (ruminations). Keeping busy with the life activities you care about it also an important part because avoiding your life to cater to OCD thoughts only makes them more powerful.

  5. Sarah September 29, 2014 at 2:14 pm - Reply

    That last paragraph helped me so much. I have been trying to learn about mindfulness and ocd treatment over the last few months, and I have had this idea that I have to make sure that I know I’m doing it “right.” I’ve read other mindfulness information that was presented as a “step-by-step” process, and trying to follow a step-by-step mental process when you have ocd that involves mental rituals basically becomes another ritual really quickly. It feels so validating for someone to take that into account when writing about ocd treatment. Thank you.

    • Stacey Kuhl-Wochner October 9, 2014 at 5:32 am - Reply

      Hi Sarah, I’m glad you found this article helpful. It is true there has to be a different set of instructions for someone with OCD because the risk is to get compulsive about doing the therapy!

  6. Tyler November 17, 2014 at 8:02 pm - Reply

    Thank you for the great article! I have a question. I’ve been obsessing over thoughts such as, am i real? Is life real? Is this all just a simulation? Is anybody real? Etc. These thoughts lead to anxiety/depression. Have you ever dealt with a case like this? If so what therapy would be the best help? Thank you for any feedback.

    • Stacey Kuhl-Wochner November 21, 2014 at 5:02 am - Reply

      Hi Tyler, Yes I have seen clients with this theme often termed, ‘existential OCD.’ The treatment is the same for all themes which is Cognitive Behavior Therapy (CBT) including Exposure and Response Prevention (ERP) and mindfulness skills training. I recommend finding an OCD specialist trained in CBT for OCD.

  7. RS December 15, 2014 at 2:49 am - Reply

    Stacy, does OCD necessarily manifest itself with people who have high IQ. My IQ score is 130 and one of my friends told me that I have OCD because of my extremely active neurons which my medication seeks to control. I have excessive guilt syndrome as well. Does this mean I would need to undergo psycho – surgery. I am extremely scared. Please advise me

    • Stacey Kuhl-Wochner December 29, 2014 at 6:34 pm - Reply

      Hi RS, OCD occurs in individuals over a broad range of intelligence levels. The first line of treatment is Cognitive-Behavioral Therapy (CBT) including Exposure and Response Prevention. It can be a very effective therapy and a reported 80% of people can get 80% better. In most cases, neurosurgery isn’t indicated unless all other evidence-based therapies and medications are exhausted. I recommend meeting with an OCD specialist for CBT.

  8. jane February 8, 2015 at 4:58 pm - Reply

    Hi Stacey, I found this article very useful, thank you.
    I’ve been practising mindfulness for a long time now and am quite good at watching the thoughts and am good at letting an unwanted thought just pass through without reacting, but I still have problems with false memories. I can have an evening out, for example, and just have a few drinks. The next day I know it was all fine and I feel fine, but perhaps three days later I will suddenly start ruminating on things. Did I do this or that? Did I suddenly flip out at the end and say something friendship-losing to someone? Then suddenly I am a slave to one false memory after another, have to text people on pretexts to check everything’s ok, or sometimes ask if I’ve offended them. (I’ve learnt to keep it vague, but still it feels damaging because somehow there is guilt attached even to the question.) I just wondered if you had any advice? In the moment it is just that it feels like to lose so-and-so as a friend would be the most terrible thing and I can’t bear it.
    Thanks again for the article.

    • Stacey Kuhl-Wochner February 24, 2015 at 5:57 pm - Reply

      Hi Jane, Keep trying to apply your mindfulness skills to intrusive thoughts, guilt and anxiety you have when you fear you have done something wrong after going out. If you are willing to take the risk you will lose the friendship, you will build the muscle for coping with these moments and it will get easier and will happen less. Also, there is a behavioral therapy called Exposure and Response Prevention. Response prevention means to avoid doing rituals that reinforce your fears. The rituals you are engaging in are checking your text messages, mental certainty-seeking and contacting friends for indirect reassurance. I may work with a client to write an imaginal exposure story about how they did offend the friend and forgot about it, are ostracized and alone the rest of their lives. The purpose of this story is to get used to having intrusive thoughts. Feel free to read my blogs about Obsessions in OCD and Real Event OCD, both may help you to understand your situation.

  9. jane February 8, 2015 at 6:10 pm - Reply

    There is background to this which is that I went through a phase a couple of years ago when I was so sick of worrying about behaving badly and making everyone hate me that I started playing up to it sometimes at parties by saying weird things to people who don’t know me well. (Cue off the scale paranoia for months.)

  10. Stacey Kuhl-Wochner February 24, 2015 at 5:43 pm - Reply

    Hi Anthony, Since you responded to my mindfulness blog, I will respond to this comment using mindfulness skills. You are telling me what you ‘notice’ when you are going to sleep…that is mindfulness. Instead of trying to change or control your thoughts, feelings and bodily sensations try to observe them. Say to yourself, “I’m noticing I am having a thought about being gay. I’m noticing this thought feels more real than it does in the daytime. I’m noticing I’m having a bodily sensation that feels scary.” Unwanted bodily sensations are normal with HOCD. Being gay doesn’t feel scary but it sounds like these thoughts are scary and unwanted for you. Keep calling it OCD and stop trying to make sense of it. Seeking the answer is a compulsion that will make the OCD worse.

  11. jane February 26, 2015 at 1:32 pm - Reply

    Thanks for your advice. I’ll keep trying! I read those blogs (think you meant Compulsions in OCD?), both great. I guess it sometimes feels like this variant of OCD is different because it’s based on a fear of something that doesn’t seem totally unlikely, but I have to recognise it’s just basic OCD anyway..

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